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  2. 4. Thyroid Gland
  3. 5. Thyroid Disorders <ul><li>Thyroid Gland produces three hormones: </li></ul><ul><ul><li>Thyroxine (T 4 ) </li></ul></ul><ul><ul><li>Triiodothyronine (T 3 ) </li></ul></ul><ul><ul><li>Calcitonin </li></ul></ul><ul><ul><li>T 3 + T 4 are referred to collectively as thyroid hormone. </li></ul></ul>
  4. 6. Thyroid-iodine connection <ul><li>Iodine is used by the thyroid to produce its hormones </li></ul><ul><ul><ul><li>T 4 - thyroxine </li></ul></ul></ul><ul><ul><ul><li>T 3 - triiodothyronine </li></ul></ul></ul><ul><ul><ul><li>Calcitonin </li></ul></ul></ul>
  5. 7. Calcitonin <ul><li>Secreted by the thyroid gland. </li></ul><ul><li>Secreted in response to high plasma levels of calcium </li></ul><ul><li>Decreases circulating plasma Ca ++ levels by increasing its deposition in bone </li></ul>
  6. 8. Thyroid Hormone: Hypofunction <ul><ul><li>Subjective : </li></ul></ul><ul><ul><li>Fatigue, weakness, forgetfulness, </li></ul></ul><ul><ul><li>Objective : </li></ul></ul><ul><ul><li>Labile BP, CO, bradycardia, MI d/t hyperlipidemia, constipation, weight gain, cold intolerance, prone to infections, depression, anxiety, </li></ul></ul>
  7. 9. Thyroid Hormone: Hyperfunction <ul><ul><li>Subjective : </li></ul></ul><ul><ul><li>Palpitations, fatigue </li></ul></ul><ul><ul><li>Objective : </li></ul></ul><ul><ul><li>HTN, HR, RR & CO, arrythmias, diarrhea, weight loss, heat intolerance, fine tremors, labile moods, insomnia, exhaustion, </li></ul></ul><ul><ul><li>Goiter, exothalmus </li></ul></ul>
  8. 10. Goiter
  9. 11. Nursing Diagnosis of Thyroid Dysfunction <ul><li>Altered metabolic function </li></ul><ul><li>Activity intolerance </li></ul><ul><li>Impaired cardiac output </li></ul><ul><li>Imbalanced nutrition </li></ul><ul><li>Anxiety </li></ul><ul><li>Potential for injury </li></ul><ul><li>Hypo/hyperthermia </li></ul><ul><li>Disturbed thought process </li></ul><ul><li>Knowledge deficit </li></ul>
  10. 12. Nursing Management of Thyroid Dysfunction <ul><li>Goal: </li></ul><ul><ul><li>Restore normal/optimal metabolic state </li></ul></ul><ul><ul><li>Prevent complications </li></ul></ul>
  11. 13. Abnormal Thyroid Function <ul><li>Hypothyroidism </li></ul><ul><ul><li>the thyroid releases too little hormone so the body's metabolism goes too slowly </li></ul></ul><ul><li>Hyperthyroidism </li></ul><ul><ul><li>where the thyroid releases too much hormone and the body's metabolism goes too fast </li></ul></ul>
  12. 14. Abnormal Thyroid Function <ul><li>Thyroid nodules and swellings </li></ul><ul><ul><li>overgrowth of thyroid tissue </li></ul></ul><ul><ul><li>resulting in a nodule or small lump, in part of the gland </li></ul></ul><ul><ul><li>a small percentage of the inactive lumps may be cancerous </li></ul></ul>
  13. 15. Hypothyroidism <ul><li>Hypothyroidism </li></ul><ul><ul><li>The body's normal rate of functioning slows, causing mental and physical sluggishness </li></ul></ul>
  14. 16. Thyroiditis <ul><li>Inflammation of the thyroid gland </li></ul><ul><li>Hashimoto’s Disease </li></ul><ul><ul><li>Chronic thyroiditis </li></ul></ul><ul><ul><li>Reaction of the immune system against the thyroid gland </li></ul></ul>
  15. 17. Hypothyroidism <ul><li>Fatigue or lack of energy </li></ul><ul><li>Weight gain </li></ul><ul><li>Feeling cold </li></ul><ul><li>Dry skin and hair </li></ul><ul><li>Heavy menstrual periods </li></ul><ul><li>Constipation </li></ul><ul><li>Slowed thinking </li></ul>
  16. 18. Hyperthyroidism <ul><li>2 nd most common endocrine disorder (after diabetes mellitus) </li></ul><ul><li>Graves’ Disease </li></ul><ul><ul><li>Excessive output of thyroid hormone caused by abnormal stimulation of the thyroid gland by circulating immunoglobulins </li></ul></ul><ul><li>Other causes </li></ul><ul><ul><li>Thyroiditis </li></ul></ul><ul><ul><li>Excessive ingestion of thyroid hormone </li></ul></ul>
  17. 20. Hyperthyroidism <ul><li>Jitteriness, shaking, increased nervousness, irritability </li></ul><ul><li>Rapid heart beat or palpitations </li></ul><ul><li>Feeling hot </li></ul><ul><li>Weight loss </li></ul><ul><li>Fatigue, feeling exhausted </li></ul><ul><li>More frequent bowel movements </li></ul><ul><li>Shorter or lighter menstrual periods </li></ul>
  18. 21. Nursing Management: Hyperthyroidism <ul><li>Reducing thyroid hyperactivity to relieve symptoms and accompanying complications </li></ul><ul><li>Radioactive Iodine (RAI) </li></ul><ul><ul><li>Disrupts the function of some of the thyroid cells </li></ul></ul><ul><ul><li>Given as a single dose </li></ul></ul><ul><ul><li>Low side effects </li></ul></ul>
  19. 22. Collaborative Management: Hyperthyroidism <ul><li>Medications </li></ul><ul><ul><li>Require long-term compliance </li></ul></ul><ul><ul><li>High rate of relapse </li></ul></ul><ul><li>Surgery </li></ul><ul><ul><li>Subtotal thyroidectomy </li></ul></ul>
  20. 23. Thyroidectomy
  21. 24. Parathyroid Glands
  22. 25. Parathyroid Glands <ul><li>Secretes parathormone (PTH) </li></ul><ul><li>PTH regulates calcium and phosphorous </li></ul>
  23. 26. Parathyroid and Calcium Regulation <ul><li>Calcium </li></ul><ul><li>most closely regulated element in our bodies!  </li></ul><ul><li>important in conduction of electrical impulses in nervous and muscular systems </li></ul><ul><li>ONLY element / mineral that has its own regulatory system  the parathyroid glands </li></ul>
  24. 27. Hyperparathyroidism <ul><li>Increase in the production of PTH </li></ul><ul><ul><li>Due to a benign growth of 1:4 parathyroid glands </li></ul></ul><ul><li>Induces: </li></ul><ul><li>abnormally high serum Ca ++ levels </li></ul><ul><li>bone decalcification </li></ul><ul><li>development of kidney stones </li></ul>
  25. 28. Hyperparathyroidism <ul><li>Fatigue </li></ul><ul><li>Apathy </li></ul><ul><li>muscle weakness </li></ul><ul><li>Vomiting </li></ul><ul><li>Hypertension </li></ul><ul><li>Bone demineralization </li></ul><ul><li>kidney stones </li></ul><ul><li>Symptoms of have become </li></ul><ul><li>known as: </li></ul><ul><li>&quot;moans, groans, stones, and bones...with psychic overtones&quot;. </li></ul>
  26. 29. Hypoparathyroidism <ul><li>Accidental removal of parathyroid glands during thyriod surgery </li></ul><ul><li>Symptoms r/t hypocalcemia & hyperphosphatemia </li></ul><ul><ul><li>Neuromuscular irritability </li></ul></ul><ul><ul><li>Tetany </li></ul></ul><ul><ul><ul><li>Numbness, tingling, cramps  </li></ul></ul></ul><ul><ul><ul><li>Bronchospasm, laryngeal spasm, carpopedal spasm </li></ul></ul></ul><ul><ul><ul><ul><li>Ca+ Gluconate </li></ul></ul></ul></ul>
  27. 30. Hypoparathyroidism <ul><li>Trousseau’s Sign of latent tetany </li></ul><ul><ul><li>Compression of the forearm in clients having undue neuromuscular excitability due to hypocalcaemia produces spasm in the hand and wrist. </li></ul></ul>
  28. 31. Hypoparathyroidism <ul><li>Chvostek’s sign of latent tetany </li></ul><ul><ul><li>contraction of the muscles of the eye, mouth or nose, elicited by tapping along the course of the facial nerve. </li></ul></ul><ul><ul><li>The examiner taps gently over the facial nerve in front of the ear. </li></ul></ul>
  29. 32. Nursing care of parathyroid dysfunction <ul><li>Subjective & objective data similar to thyroid dysfunction </li></ul><ul><li>Blood level >10 or </li></ul><ul><li>< 3 very significant </li></ul><ul><li>Nursing Diagnosis </li></ul><ul><ul><li>Altered metabolism </li></ul></ul><ul><ul><li>Altered cardiac output </li></ul></ul><ul><ul><li>Anxiety </li></ul></ul><ul><ul><li>Altered comfort </li></ul></ul><ul><ul><li>Impaired memory </li></ul></ul>
  30. 33. Corticosteroid Therapy “Steroids” <ul><li>Used to treat adrenal insufficiency </li></ul><ul><li>Suppress inflammation & autoimmune reactions, control allergic reactions & reduce organ transplant rejection </li></ul><ul><li>Side effects of high doses over long-term turned steroid use into “scare-oids” </li></ul>
  31. 34. “ Steroids” - How do they work? <ul><ul><li>Cortisol controls salt & water balance in the body </li></ul></ul><ul><ul><li>Stress  pituitary gland releases adrenocorticotropic hormone (ACTH) which stimulates adrenals to produce cortisol </li></ul></ul><ul><ul><li>Extra cortisol allows body to cope with stress of infections, trauma, surgery, or emotional problems </li></ul></ul><ul><ul><li>When stressful situation resolves, adrenal hormone function returns to normal </li></ul></ul>
  32. 35. Corticosteroid Therapy <ul><li>Block production of substances that trigger allergic and inflammatory actions (i.e. prostaglandins). </li></ul><ul><li>Impede the function of WBC’s which help keep the immune system functioning properly </li></ul><ul><li>Undesirable side effect: susceptibility to infection </li></ul>